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Surgical resection of metastatic renal cell carcinoma (mRCC) has been associated with better cancer-specific survival; however, high-quality data on its perioperative morbidity are lacking. Existing population-based data are severely limited by reliance on billing claims to identify outcomes, which may overestimate events owing to a lack of code specificity.To study 30-d complications after metastasectomy for mRCC.The study involved a retrospective cohort of patients who underwent metastasectomy for mRCC between 2005 and 2020 at two high-volume centers.We used generalized estimating equations for a binary response to evaluate associations of features with 30-d complications classified according to Clavien-Dindo grade.A total of 740 metastasectomies in 522 patients were identified, including 543 performed in the Mayo Clinic and 197 in UZ Leuven. Among the 740 metastasectomies, 193 (26%, 95% confidence interval [CI] 23-29%) had a 30-d complication and 62 (8%, 95% CI 7-11%) had a major (Clavien-Dindo III-V) complication, including eight (1%) perioperative deaths. Age, body mass index, American Society of Anesthesiologists score, metastasectomy concurrent with nephrectomy, multiple sites of metastasis, pancreatic resection, and metastasis size were significantly associated with postoperative complications (all p 0.05). Age, multiple sites of metastasis, and pancreatic resection were significantly associated with major (Clavien-Dindo III-V) complications (all p 0.05). Limitations include the retrospective design and surgical selection bias.In this multi-institutional series, fewer than 10% of metastasectomies for mRCC resulted in a major complication within 30 d of surgery, which is considerably lower than previously observed in population-based data. Favorable perioperative outcomes can be achieved with metastasectomy at high-volume centers in well-selected patients.In this study we found that fewer than 10% of patients who underwent surgical removal of one or more sites of metastatic kidney cancer experienced a major complication within 30 days of surgery.

The Proteeae group (i.e., Proteus species, Morganella morganii, and Providencia species) frequently causes urinary tract infections (UTIs) and is generally resistant to nitrofurantoin. Proteeae species can produce urease, which can increase urine pH.Our aim was to determine whether higher urine pH in the emergency department is associated with nitrofurantoin resistance.A single health system database of emergency department patients aged 18 years and older who received urinalysis between April 18, 2014, and March 7, 2017, was examined using χOf 67,271 urine samples analyzed, 13,456 samples grew a single bacterial species. Urine cultures growing the Proteeae group were associated with significantly more alkaline urine than other bacteriuria cultures (odds ratio [OR] 2.20, 95% confidence interval [CI] 2.06-2.36; p0.001). The Proteeae species represented 4.4% of urine samples at pH 5-7, 24.4% at pH 8-9, and 40.0% at pH 9. At urine pH 5-7, 80.4% of urine samples were sensitive to nitrofurantoin; however, this percentage decreased to 66.1% for urine pH 8-9 and 54.6% for urine pH 9. Nitrofurantoin had the highest OR (2.10, 95% CI 1.85-2.39) among cefazolin, ciprofloxacin, and trimethoprim/sulfamethoxazole for bacteriuria sensitive to those antibiotics at urine pH 5-7. At urine pH 8-9 and 9, nitrofurantoin had the lowest OR among the antibiotics: 0.48 (95% CI 0.42-0.54) and 0.31 (95% CI 0.24-0.40), respectively (p0.001 for both).Urine pH of 8 or higher is associated with high rates of nitrofurantoin resistance.

OBJECTIVES To characterize 30-day morbidity of upper ureteral reconstruction (UUR) and lower ureteral reconstruction (LUR) surgery by comparing open and minimally invasive surgery (MIS) approaches using a national surgical outcomes registry. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was reviewed for patients who underwent UUR and LUR between 2007-2017. Primary endpoints included 30-day complications, transfusion, readmission, return to operating room (ROR), and prolonged postoperative length of stay (LOS). Multivariable logistic regression was performed to observe the association of MIS approach on 30-day outcomes. RESULTS 3042 patients were identified with 2116 undergoing UUR and 926 undergoing LUR. Of 2116 patients undergoing UUR, 1733 (82%) were performed via MIS approach. On multivariable analysis, open approach for UUR was associated with increased odds of any 30-day complication (odds ratio (OR) 1.6 [1.1-2.4]; p=0.014), major complication (OR 1.8 [1.04-3.0]; p=0.034), transfusion (OR 3.7 [1.2- 11.5]; p=0.025), ROR (OR 2.0 [1.0-3.9]; p=0.047), and prolonged LOS (OR 5.4 [3.9-7.6]; p

Forensic interviewers are taught to pair yes–no questions with open-ended requests for recall in order to reduce the likelihood that they will be misled by false “yes” responses. However, yes–no questions may elicit false “no” responses. Questioning 112 6- to 11-year-old maltreated children about three innocuous events (outside activities, yesterday, last birthday), this study compared the productivity of paired yes–no questions about perceptions, conversations, and actions involving the hands and mouth (e.g., “Did you say anything?”) with wh-questions (e.g., “What did you say?”). The wh-questions presupposed that children had content to provide, but did not specify that content. Children were twice as likely to deny content and half as likely to provide novel information when interviewers asked them yes–no questions. Younger children were more inclined than older children to deny content and give unelaborated “yes” responses. The results support further research into the potential for suppositional wh-questions to increase child witnesses’ productivity.

The bacterial ribosomal protein S15 is located in the platform, a functional region of the 30S ribosomal subunit. While S15 is critical for in vitro formation of E. coli small subunits (SSUs), it is dispensable for in vivo biogenesis and growth. In this work, a novel synergistic interaction between rpsO, the gene that encodes S15, and rnc (the gene that encodes RNase III), was uncovered in E. coli. RNase III catalyzes processing of precursor ribosomal RNA (rRNA) transcripts and thus is involved in functional ribosome subunit maturation. Strains lacking S15 (ΔrpsO), RNase III (Δrnc) or both genes were examined to understand the relationship between these two factors and the impact of this double deletion on rRNA processing and SSU maturation. The double deletion of rpsO and rnc partially alleviates the observed cold sensitivity of ΔrpsO alone. A novel 16S rRNA precursor (17S∗ rRNA) that is detected in free 30S subunits of Δrnc is incorporated in 70S-like ribosomes in the double deletion. The stable accumulation of 17S∗ rRNA suggests that timing of processing events is closely coupled with SSU formation events in vivo. The double deletion has a suppressive effect on the cell elongation phenotype of ΔrpsO. The alteration of the phenotypes associated with S15 loss, due to the absence of RNase III, indicates that pre-rRNA processing and improvement of growth, relative to that observed for ΔrpsO, are connected. The characterization of the functional link between the two factors illustrates that there are redundancies and compensatory pathways for SSU maturation.

The purpose of this study was to identify motivations for fourth-year veterinary students to choose future career paths based on post-graduation employment or post-graduation education. Approximately 500 students from four institutions were invited to participate in an online survey. Surveys were based on the cognitive evaluation theory, a minitheory within the self-determination macrotheory framework developed by Deci and Ryan. Intrinsic motivational factors were categorized by autonomy, competence, and relatedness, and extrinsic motivators were categorized by environmental and interpersonal factors. Students pursuing post-graduation education have intrinsic motivators that aligned with competence and were extrinsically motivated by a mentor, while students interested in post-graduation employment had intrinsic motivators that were more focused on autonomy with extrinsic motivational influences of debt/finances and geographic location.

Centralization of radical cystectomy (RC) improves outcomes but may unintentionally exacerbate existing disparities in care. Our objective was to assess disparities in access to high-volume RC centers and in postoperative recovery.We identified RC patients in the Florida Inpatient Data File from 2013 to 2019. Hospital annual cystectomy volume was categorized as low, medium, or high using data-derived 75th and 90th quantiles:5, 5 to 13, and13 RC/year. Outcomes included inpatient mortality, non-home discharge, in-hospital complications, length of stay (LOS) and surgery in a low-volume hospital. Mixed-effects regression models accounting for clustering within centers were utilized.Among 4,396 patients treated at 105 centers, RC at a high-volume center was associated with lower odds of mortality, non-home discharge, shorter length of stay and fewer complications (all P ≤ 0.001). Characteristics associated with receiving care in a low-volume hospital included Black race (OR 1.67, 95% CI 1.14-2.39), Hispanic/Latino ethnicity (OR 1.74, 95% CI 1.32-2.00), and residing in northeast (OR 2.11, 95% CI 1.58-2.80) or west Florida (OR 1.34, 95% CI 1.05-1.71). Black patients had increased odds of non-home discharge (OR 1.91, 95% CI 1.27-2.86) and longer LOS (IRR 1.17, 95% CI 1.08-1.27), but no difference in the rate or number of postoperative complications (P0.2).In Florida, we observed racial and geographic disparities in likelihood of undergoing RC at a high-volume hospital, and that Black patients experienced longer LOS and lower odds of home discharge despite similar rates of complications. Efforts to increase access to high-value RC care for these vulnerable populations are needed.

Our objective was to examine whether perioperative blood transfusion is associated with venous thromboembolism following radical cystectomy adjusting for both patient- and disease-related factors.Patients who underwent radical cystectomy for bladder cancer from 1980-2020 were identified in the Mayo Clinic cystectomy registry. Blood transfusion during the initial postoperative hospitalization was analyzed as a 3-tiered variable: no transfusion, postoperative transfusion alone, or intraoperative with or without postoperative transfusion. The primary outcome was venous thromboembolism within 90 days of radical cystectomy. Associations between clinicopathological variables and 90-day venous thromboembolism were assessed using multivariable logistic regression, with transfusion analyzed as both a categorical and a continuous variable.A total of 3,755 radical cystectomy patients were identified, of whom 162 (4.3%) experienced a venous thromboembolism within 90 days of radical cystectomy. Overall, 2,112 patients (56%) received a median of 1 (IQR: 0-3) unit of blood transfusion, including 811 (38%) with intraoperative transfusion only, 572 (27%) with postoperative transfusion only, and 729 (35%) with intraoperative and postoperative transfusion. On multivariable analysis, intraoperative with or without postoperative blood transfusion was associated with a significantly increased risk of venous thromboembolism (adjusted OR 1.73, 95% CI 1.17-2.56,Intraoperative blood transfusion was significantly associated with venous thromboembolism within 90 days of radical cystectomy. To ensure optimal perioperative outcomes, continued effort to limit blood transfusion in radical cystectomy patients is warranted.

Adults often fail to recognize the ambiguity of children’s unelaborated responses to ‘Do you know/remember (DYK/R) if/whether’ questions. Two studies examined whether sample questions and/or an explicit instruction would improve adults’ ability to recognize referential ambiguity in children’s testimony. In Study 1 (N = 383), participants rarely recognized referential ambiguity in the sample questions or in children's testimony, and answering sample questions had no influence on their ability to detect ambiguity in children’s testimony. Study 2 (N = 363) attempted to clarify the meaning of ambiguity for participants with explicit instructions. Results revealed that although an explicit instruction improved performance on sample questions, this also led to an overcorrection, and instructions and sample questions only modestly improved adults’ ability to recognize referential ambiguity in children’s testimony. Ultimately, the absence of an effective strategy for alerting adults to the problem of referential ambiguity highlights the dangers of DYK/R if/whether questions.

Objective To emulate the GRADE (Glycemia Reduction Approaches in Diabetes: A Comparative Effectiveness Study) trial using real world data before its publication. GRADE directly compared second line glucose lowering drugs for their ability to lower glycated hemoglobin A 1c (HbA 1c ). Design Observational study. Setting OptumLabs® Data Warehouse (OLDW), a nationwide claims database in the US, 25 January 2010 to 30 June 2019. Participants Adults with type 2 diabetes and HbA 1c 6.8-8.5% while using metformin monotherapy, identified according to the GRADE trial specifications, who also used glimepiride, liraglutide, sitagliptin, or insulin glargine. Main outcome measures The primary outcome was time to HbA 1c ≥7.0%. Secondary outcomes were time to HbA 1c >7.5%, incident microvascular complications, incident macrovascular complications, adverse events, all cause hospital admissions, and all cause mortality. Propensity scores were estimated using the gradient boosting machine method, and inverse propensity score weighting was used to emulate randomization of the treatment groups, which were then compared using Cox proportional hazards regression. Results 8252 people were identified (19.7% of adults starting the study drugs in OLDW) who met eligibility criteria for the GRADE trial (glimepiride arm=4318, liraglutide arm=690, sitagliptin arm=2993, glargine arm=251). The glargine arm was excluded from analyses owing to small sample size. Median times to HbA 1c ≥7.0% were 442 days (95% confidence interval 394 to 480 days) for glimepiride, 764 (741 to not calculable) days for liraglutide, and 427 (380 to 483) days for sitagliptin. Liraglutide was associated with lower risk of reaching HbA 1c ≥7.0% compared with glimepiride (hazard ratio 0.57, 95% confidence interval 0.43 to 0.75) and sitagliptin (0.55, 0.41 to 0.73). Results were consistent for the secondary outcome of time to HbA 1c >7.5%. No significant differences were observed among treatment groups for the remaining secondary outcomes. Conclusions In this emulation of the GRADE trial, liraglutide was statistically significantly more effective at maintaining glycemic control than glimepiride or sitagliptin when added to metformin monotherapy. Generating timely evidence on medical treatments using real world data as a complement to prospective trials is of value.

IntroductionAdults are typically poor judges of the veracity of statements, requiring the need for alternative methods for detecting lies. One alternative method to human lie-detectors is using computer-based linguistic analysis which may present a more reliable method for detecting dishonesty. Moreover, while previous research has examined linguistic differences between typically developing children’s and adults’ truthful and dishonest reports, no study to date has examined whether maltreated children exhibit different linguistic cues to dishonesty. Thus, the current study examined maltreated and nonmaltreated children’s linguistic and syntactic cues to children’s truthful and dishonest reports.MethodsNine- to 12-year-olds, half of whom were maltreated, played a computer game with a confederate: half of the children experienced a transgression (i.e., playing a forbidden game and crashing the computer) and were coached to conceal it, and half of the children experienced no transgression (i.e., simply played a computer game). All children were then interviewed about the event. The current study utilized automated linguistic and syntactic analysis software to compare children’s truthful reports (no transgression occurred) with dishonest reports.Results and DiscussionResults indicated that maltreated and non-maltreated children did not differ in their indicators of dishonesty. Dishonest reporters used more first-person plural pronouns and cognitive mechanism terms and had less syntactically complex reports compared to truthful reporters. Finally, first-personal plural pronouns, cognitive mechanism terms, and syntactic complexity accurately classified (74.2%) the veracity of children’s reports. The current findings present a new indicator of dishonesty (syntactic complexity) and suggest that indicators from typically developing populations may apply to maltreated children when coaching occurred.

Purpose: Previous research has established that lie-detection accuracy decreases with age; however, various mechanisms for this effect have yet to be explored, particularly when examining the detection of children’s lies. The present study investigated if younger and older adults detect children’s lies using different cues (verbal-content, verbal-auditory, non-verbal, global traits) to explore if cue usage may help to explain this age-related decline. Method: A total of 100 younger (18-30 years) and 100 older adults (66-89 years) watched child interview videos (half were truth-tellers; half were lie-tellers coached to conceal a transgression). Participants provided veracity judgments (truth vs. lie) and described the cues that they relied on to make their judgments. Results: Older adults used marginally significantly fewer verbal-content and significantly more global trait cues compared to younger adults. The use of global trait cues partially mediated the age-related decline in detection accuracy. Conclusion: These results present a partial mechanism for the age-related decline in deception detection. This can inform psychological theory on how aging affects perceptions of child witnesses and deception detection abilities.